401k Plan data: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 plan

GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 401k Plan overview

Plan Name	GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2
Plan identification number	007

GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

GENESIS ADMINISTRATIVE SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: GENESIS ADMINISTRATIVE SERVICES, LLC

Employer identification number (EIN): 300847166

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
007 2022-01-01
007 2021-01-01
007 2020-11-23

Plan Statistics for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2

401k plan membership statisitcs for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2

Measure Date Value
2022: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2022 401k membership
Total participants, beginning-of-year 2022-01-01 4,042
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3,469
Number of retired or separated participants receiving benefits 2022-01-01 33
Number of other retired or separated participants entitled to future benefits 2022-01-01 2,024
Total of all active and inactive participants 2022-01-01 5,526
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 5,526
Number of participants with account balances 2022-01-01 5,526
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2021 401k membership
Total participants, beginning-of-year 2021-01-01 19,817
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 2,563
Number of retired or separated participants receiving benefits 2021-01-01 30
Number of other retired or separated participants entitled to future benefits 2021-01-01 1,449
Total of all active and inactive participants 2021-01-01 4,042
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 4,042
Number of participants with account balances 2021-01-01 4,042
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 10
2020: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2020 401k membership
Total participants, beginning-of-year 2020-11-23 20,723
Total number of active participants reported on line 7a of the Form 5500 2020-11-23 18,390
Number of retired or separated participants receiving benefits 2020-11-23 21
Number of other retired or separated participants entitled to future benefits 2020-11-23 1,406
Total of all active and inactive participants 2020-11-23 19,817
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-11-23 0
Total participants 2020-11-23 19,817
Number of participants with account balances 2020-11-23 5,162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-11-23 27

Measure	Date	Value
2022: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2022 401k membership
Total participants, beginning-of-year	2022-01-01	4,042
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,469
Number of retired or separated participants receiving benefits	2022-01-01	33
Number of other retired or separated participants entitled to future benefits	2022-01-01	2,024
Total of all active and inactive participants	2022-01-01	5,526
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	5,526
Number of participants with account balances	2022-01-01	5,526
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2021 401k membership
Total participants, beginning-of-year	2021-01-01	19,817
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	2,563
Number of retired or separated participants receiving benefits	2021-01-01	30
Number of other retired or separated participants entitled to future benefits	2021-01-01	1,449
Total of all active and inactive participants	2021-01-01	4,042
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	4,042
Number of participants with account balances	2021-01-01	4,042
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	10
2020: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2020 401k membership
Total participants, beginning-of-year	2020-11-23	20,723
Total number of active participants reported on line 7a of the Form 5500	2020-11-23	18,390
Number of retired or separated participants receiving benefits	2020-11-23	21
Number of other retired or separated participants entitled to future benefits	2020-11-23	1,406
Total of all active and inactive participants	2020-11-23	19,817
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-11-23	0
Total participants	2020-11-23	19,817
Number of participants with account balances	2020-11-23	5,162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-11-23	27

Financial Data on GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2

Measure	Date	Value
2022 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total transfer of assets to this plan	2022-12-31	$11,492,970
Total transfer of assets from this plan	2022-12-31	$348,355
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$102,216
Total income from all sources (including contributions)	2022-12-31	$-7,709,091
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$16,695,078
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$16,207,843
Expenses. Certain deemed distributions of participant loans	2022-12-31	$172,787
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$10,816,335
Value of total assets at end of year	2022-12-31	$101,879,257
Value of total assets at beginning of year	2022-12-31	$115,241,027
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$314,448
Total interest from all sources	2022-12-31	$92,544
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$181,615
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$181,615
Administrative expenses professional fees incurred	2022-12-31	$56,050
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$10,398,507
Participant contributions at end of year	2022-12-31	$2,256,835
Participant contributions at beginning of year	2022-12-31	$2,293,864
Participant contributions at end of year	2022-12-31	$232,465
Participant contributions at beginning of year	2022-12-31	$195,385
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$269,704
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$102,216
Other income not declared elsewhere	2022-12-31	$74,131
Administrative expenses (other) incurred	2022-12-31	$65,931
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-24,404,169
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$101,879,257
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$115,138,811
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$75,000
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$11,482,256
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$14,534,772
Value of interest in pooled separate accounts at end of year	2022-12-31	$11,134,223
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$15,810,663
Interest on participant loans	2022-12-31	$92,544
Value of interest in common/collective trusts at end of year	2022-12-31	$76,731,648
Value of interest in common/collective trusts at beginning of year	2022-12-31	$82,403,364
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,896,649
Net investment gain/loss from pooled separate accounts	2022-12-31	$-4,846,663
Net investment gain or loss from common/collective trusts	2022-12-31	$-11,130,404
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$148,124
Employer contributions (assets) at end of year	2022-12-31	$41,830
Employer contributions (assets) at beginning of year	2022-12-31	$2,979
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$16,207,843
Contract administrator fees	2022-12-31	$117,467
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	EISNERAMPER LLP
Accountancy firm EIN	2022-12-31	871363769
2021 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total transfer of assets to this plan	2021-12-31	$1,271,670
Total transfer of assets from this plan	2021-12-31	$363,640
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$102,216
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$22,037,345
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$23,659,878
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$23,293,345
Expenses. Certain deemed distributions of participant loans	2021-12-31	$97,939
Value of total corrective distributions	2021-12-31	$32,008
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$9,009,553
Value of total assets at end of year	2021-12-31	$115,241,027
Value of total assets at beginning of year	2021-12-31	$115,853,314
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$236,586
Total interest from all sources	2021-12-31	$113,758
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$189,991
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$189,991
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$8,221,277
Participant contributions at end of year	2021-12-31	$2,293,864
Participant contributions at beginning of year	2021-12-31	$3,447,649
Participant contributions at end of year	2021-12-31	$195,385
Participant contributions at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$640,285
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$102,216
Other income not declared elsewhere	2021-12-31	$84,876
Administrative expenses (other) incurred	2021-12-31	$236,586
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-1,622,533
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$115,138,811
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$115,853,314
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$14,534,772
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$13,778,270
Value of interest in pooled separate accounts at end of year	2021-12-31	$15,810,663
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$17,093,817
Interest on participant loans	2021-12-31	$113,758
Value of interest in common/collective trusts at end of year	2021-12-31	$82,403,364
Value of interest in common/collective trusts at beginning of year	2021-12-31	$81,533,578
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$2,833,822
Net investment gain/loss from pooled separate accounts	2021-12-31	$2,164,020
Net investment gain or loss from common/collective trusts	2021-12-31	$7,641,325
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$147,991
Employer contributions (assets) at end of year	2021-12-31	$2,979
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$23,293,345
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	EISNERAMPER LLP
Accountancy firm EIN	2021-12-31	871363769
2020 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$112,155,805
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$5,405,046
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,707,537
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,677,580
Expenses. Certain deemed distributions of participant loans	2020-12-31	$28,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,143,465
Value of total assets at end of year	2020-12-31	$115,853,314
Value of total assets at beginning of year	2020-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,925
Total interest from all sources	2020-12-31	$17,094
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$60,047
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$60,047
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,112,710
Participant contributions at end of year	2020-12-31	$3,447,649
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$1,192
Administrative expenses (other) incurred	2020-12-31	$1,925
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$3,697,509
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$115,853,314
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$13,778,270
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$0
Value of interest in pooled separate accounts at end of year	2020-12-31	$17,093,817
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$0
Interest on participant loans	2020-12-31	$17,094
Value of interest in common/collective trusts at end of year	2020-12-31	$81,533,578
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,251,611
Net investment gain/loss from pooled separate accounts	2020-12-31	$588,125
Net investment gain or loss from common/collective trusts	2020-12-31	$2,344,704
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$29,563
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,677,580
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	Yes
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No

Form 5500 Responses for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2

2022: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #2 2020 form 5500 responses
2020-11-23	Type of plan entity	Mulitple employer plan
2020-11-23	First time form 5500 has been submitted	Yes
2020-11-23	Submission has been amended	No
2020-11-23	This submission is the final filing	No
2020-11-23	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-11-23	Plan is a collectively bargained plan	Yes
2020-11-23	Plan funding arrangement – Insurance	Yes
2020-11-23	Plan funding arrangement – Trust	Yes
2020-11-23	Plan benefit arrangement – Insurance	Yes
2020-11-23	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

064277

Policy instance

Insurance contract or identification number	064277
Number of Individuals Covered	5526
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

075620

Policy instance

Insurance contract or identification number	075620
Number of Individuals Covered	5526
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

064277

Policy instance

Insurance contract or identification number	064277
Number of Individuals Covered	4042
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

075620

Policy instance

Insurance contract or identification number	075620
Number of Individuals Covered	4042
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

064277

Policy instance

Insurance contract or identification number	064277
Number of Individuals Covered	5162
Insurance policy start date	2020-11-23
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

075620

Policy instance

Insurance contract or identification number	075620
Number of Individuals Covered	5162
Insurance policy start date	2020-11-23
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GENESIS ADMINISTRATIVE SERVICES, LLC
Employer identification number (EIN):	300847166
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities